“Shin splints” (medial tibial stress syndrome) are a common, painful condition most frequently found in distance runners. Shin splints are pain of the shins or of the inner part of the lower leg due to repetitive impact. If left untreated or ignored shin splints can lead to stress fractures of the lower leg. The pain typically starts as a dull ache, which usually goes away with rest, but gradually will worsen if activity does not change. There may be associated numbness. Depending on the severity, sometimes if it difficult to tell if the condition has developed into a stress fracture.

What are the three things to do to prevent shin splints and what are the three things to do to treat shin splints if the symptoms develop?

This is the third in a series of articles on prevention and treatment of common running injuries. To recap the benefits of brisk walking, jogging or running, these activities provide a natural high, lower stress, improve cholesterol, blood pressure and blood sugar, and provide a way to enjoy the outdoors as it warms up outside. Exercise is the absolute best thing for your health, better than any pill a doctor can prescribe for many physical and mental health concerns.

To reiterate from the previous articles in this series, many of us are too enthusiastic when we start. We are either unprepared (as in equipment, training or warming up) or we try to do too much too fast. Most running and sports injuries occur when people are too eager and forget to gradually increase the difficulty of a workout.

The following are some tips for recreational joggers to help prevent the most common running injuries.

To prevent shin splints:

1. Long-distance runners who run on hard pavement should look for ways to run on softer surfaces. Running on grass or a track made of recycled rubber or wood chips is much gentler on the shins than running on pavement. Of note, casual runners are much less likely to develop this condition than very intense runners such as competitive cross-country runners, military recruits or the most motivated long-distance runners.

2. If pain develops even when running on softer surfaces, better cushioned shoes with waffle soles might be helpful. Remember to use running shoes that have not broken down: A general rule of thumb is when you have accumulated 300 to 400 miles total - less (sooner) if you are big or run on hard surfaces. Many people find that every six months is easier to remember. Some people can go longer, some less.

3. Daily stretching. Stretches should include pointing the toes to stretch the muscles along the front of the lower leg, and rotating the ankle in and out gently to stretch the muscles on the sides of the lower leg. 4. Daily calf stretching. The easiest technique to stretch the calf is either to use a wall or to use a step such as on the stairs or a front porch step. • Using a wall, lean forward on the wall with your heel out behind you and slowly put pressure on the forefoot to develop a stretch in the lower calf and Achilles tendon. Then, gradually straighten your leg until you feel stretching in the upper calf. These two techniques stretch different parts of the calf muscles and ligaments. • Using a step, place the front part of your foot on the step, letting your heel hang off behind the step. Gradually put weight on that leg until you feel the gentle pulling/stretching in the calf muscle.

To treat shin splints:

1. Rest. Unfortunately, this condition will not improve without decreasing the mileage for a while. A useful acronym in the treatment of sports injuries is “RICE,” which stands for Rest, Ice, Elevation and Compression. These things are all useful with shin splints. Athletes must rest until they are pain-free before returning to a running or jogging routine. Often 4-6 weeks is required. Your relative rest should be followed by a very gradual return to activity (as noted below).

2. Ice the inner part of the shin daily and after any activities (a frozen bag of peas or corn works well) for about 15-20 minutes at a time, over a washcloth or something to prevent direct freezing of the skin.

3. If you do not have a history of stomach ulcers or acid indigestion (or GERD), or kidney problems or allergy, a brief period (5 to 7 days) of ibuprofen (600 mg, three times a day) might help. If you are at all unsure, consult with your doctor.

4. Shorten your stride. A shorter running stride will decrease the amount of impact the shin has to absorb, thus reducing the damage.

5. Change the heel impact. Sometimes an orthotic that changes the heel impact (heel counter) might help.

6. Before returning to running activities, consider strengthening exercises for the muscles surrounding the shins. Tracing the ABCs with your toes in the air while sitting otherwise relaxed (such as during down time in the evenings) is a good start. Physical therapy modalities may be even more helpful. ”Running” in a pool to build strength without the impact is even better. Finally, if all of the above techniques do not help you at home after a couple weeks, it is important to be evaluated by a professional. As noted above, it is often very difficult to distinguish between shin splints and stress fractures. Very thin individuals are particularly susceptible to stress fractures. Your doctor may recommend X-rays, bone scans or MRIs to confirm the diagnosis, but not always. Stress fractures will definitely require rest, for at least six weeks. Some cases may need to be non-weight bearing, but only if walking is painful. Sometimes a removable cast is used. Also, a physical therapy evaluation that includes an assessment of biomechanical factors may be recommended in these cases.

When in doubt, rest a while and only once you are pain-free, resume your exercise at a very easy distance and pace, only increasing by about 10 percent a week, no more. These are very general guidelines. Serious athletes should see their doctor sooner. Any time these tips do not seem to help, it is a very good idea to come in to your doctor and have a dedicated evaluation to aid healing and especially to prevent an injury from becoming something more serious.

Next issue read more about Achilles tendonitis.

This guest commentary Running from Injuries was written by one of the physicians on the Packard Health staff who practices with Dr. Rion, Holly Ross, M.D. Dr. Ross completed her residency at the University of Michigan Health System in 2009. Prior to that, Dr. Ross practiced family medicine in Vermont and from 2001-2004, she was a United States Navy flight surgeon. Dr. Ross sees patients of all ages and has a special interest in sports medicine, care of chronic medical conditions, women’s health, and the care of veterans and their families. Both she and Dr. Rion can be reached at info@packardhealth.org